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European Radiology
Published in: European Radiology 11/2017

Open Access 01-11-2017 | Chest

Malignancy estimation of Lung-RADS criteria for subsolid nodules on CT: accuracy of low and high risk spectrum when using NLST nodules

Authors: Kaman Chung, Colin Jacobs, Ernst T. Scholten, Onno M. Mets, Irma Dekker, Mathias Prokop, Bram van Ginneken, Cornelia M. Schaefer-Prokop

Published in: European Radiology | Issue 11/2017

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Abstract

Purpose

Lung-RADS proposes malignancy probabilities for categories 2 (<1%) and 4B (>15%). The purpose of this study was to quantify and compare malignancy rates for Lung-RADS 2 and 4B subsolid nodules (SSNs) on a nodule base.

Methods

We identified all baseline SSNs eligible for Lung-RADS 2 and 4B in the National Lung Screening Trial (NLST) database. Solid cores and nodule locations were annotated using in-house software. Malignant SSNs were identified by an experienced radiologist using NLST information. Malignancy rates and percentages of persistence were calculated.

Results

Of the Lung-RADS 2SSNs, 94.3% (1790/1897) could be located on chest CTs. Likewise, 95.1% (331/348) of part-solid nodules ≥6 mm in diameter could be located. Of these, 120 had a solid core ≥8 mm, corresponding to category 4B. Category 2 SSNs showed a malignancy rate of 2.5%, exceeding slightly the proposed rate of <1%. Category 4B SSNs showed a malignancy rate of 23.9%. In both categories one third of benign lesions were transient.

Conclusion

Malignancy probabilities for Lung-RADS 2 and 4B generally match malignancy rates in SSNs. An option to include also category 2 SSNs for upgrade to 4X designed for suspicious nodules might be useful in the future. Integration of short-term follow-up to confirm persistence would prevent unnecessary invasive work-up in 4B SSNs.

Key points

• Malignancy probabilities for Lung-RADS 2/4B generally match malignancy risks in SSNs.
• Transient rate between low-risk Lung-RADS 2 and high-risk 4B lesions were similar.
• Upgrade of highly suspicious Lung-RADS 2 SSNs to Lung-RADS 4X might be useful.
• Up to one third of the benign high-risk Lung-RADS 4B lesions were transient.
• Short-term follow-up confirming persistence would avoid unnecessary invasive work-up of 4B lesions.
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Metadata
Title
Malignancy estimation of Lung-RADS criteria for subsolid nodules on CT: accuracy of low and high risk spectrum when using NLST nodules
Authors
Kaman Chung
Colin Jacobs
Ernst T. Scholten
Onno M. Mets
Irma Dekker
Mathias Prokop
Bram van Ginneken
Cornelia M. Schaefer-Prokop
Publication date
01-11-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 11/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-4842-8

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